DE-MR simulation imaging for prone radiotherapy after breast-conserving surgery: assessing its application in lumpectomy cavity delineation based on deformable image registration

Abstract Background The application of delayed-enhancement magnetic resonance (DE-MR) simulation imaging in lumpectomy cavity (LC) delineation for prone radiotherapy in patients with an invisible seroma or a low seroma clarity score (SCS) after breast-conserving surgery (BCS) based on deformable image registration (DIR) was assessed. Methods Twenty-six patients who were suitable for radiotherapy in prone positions after BCS were enrolled, and both computed tomography (CT) and DE-MR simulation scans were acquired. The LC delineated based on titanium surgical clips on CT images was denoted as LCCT. The LC delineated based on the signal of cavity boundaries on fat-suppressed T2-weighted imaging (T2WI) and multiphase delayed-enhancement T1-weighted imaging (DE-T1WI), which was performed at 2 min, 5 min and 10 min postinjection, were denoted as LCT2, LC2T1, LC5T1 and LC10T1, respectively. Afterwards, DIR was performed to compare the volumes and locations of the LCs with MIM software. The generalized conformity index (CIgen) of inter (intra) observer (Inter-CIgen and Intra-CIgen) was also used to explore the inter(intra) observer variation for LC delineation on each image modality. Results LCCT–LC10T1 provided the best conformal index (CI) and degree of inclusion (DI), increasing by 2.08% and 4.48% compared to LCCT–LCT2, 11.36% and 2.94% for LCCT–LC2T1, and 8.89% and 7.69% for LC5T1–LCCT, respectively. The center of mass (COM) of LCCT–LC10T1 decreased by 17.86%, 6.12% and 13.21% compared with that of LCCT–LCT2, LCCT–LC2T1 and LCCT–LC5T1, respectively. The agreement of LC delineation was strongest for 10th min DE-TIWI (coefficient of variation, COV = 2.30%, Inter-CIgen = 87.06%, Intra-CIgen = 92.64%). Conclusion For patients with a low SCS (SCS ≤ 2) after BCS, it is feasible to contour the LC based on prone DE-MR simulation images. Furthermore, the LC derived from prone DE-T1WI at 10 min was found to be most similar to that derived from prone CT simulation scans using titanium surgical clips regardless of the volume and location of the LC. Inter (intra) variability was minimal for the delineation of the LC based on 10th min DE-TIWI.

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Delayed-enhancement magnetic resonance simulation imaging for prone radiotherapy after breast-conserving surgery: Assessing its application in lumpectomy cavity delineation based on deformable image registration

10.21203/rs.3.rs-306339/v1 ◽

2021 ◽

Author(s):

changhui Zhao ◽

Jianbin Li ◽

Wei Wang ◽

Guanzhong Gong ◽

Liang Xu ◽

...

Keyword(s):

Magnetic Resonance ◽

Image Registration ◽

Center Of Mass ◽

Deformable Image Registration ◽

Breast Conserving Surgery ◽

Observer Variation ◽

Delayed Enhancement ◽

Conformity Index ◽

Surgical Clips ◽

Lumpectomy Cavity

Abstract Background The application of delayed-enhancement magnetic resonance (DE-MR) simulation imaging in lumpectomy cavity (LC) delineation for prone radiotherapy in patients with an invisible seroma or a low seroma clarity score (SCS) after breast-conserving surgery (BCS) based on deformable image registration (DIR) was assessed. Methods Twenty-six patients who were suitable for radiotherapy in prone positions after BCS were enrolled, and both computed tomography (CT) and DE-MR simulation scans were acquired. The LC delineated based on titanium surgical clips on CT images was denoted as LCCT. The LC delineated based on the signal of cavity boundaries on fat-suppressed T2-weighted imaging (T2WI) and multiphase delayed-enhancement T1-weighted imaging (DE-T1WI), which was performed at 2 min, 5 min and 10 min postinjection, were denoted as LCT2, LC2T1, LC5T1 and LC10T1, respectively. Afterwards, DIR was performed to compare the volumes and locations of the LCs with MIM software. The generalized conformity index (CIgen) of inter (intra) observer (Inter-CIgen and Intra-CIgen) was also used to explore the inter(intra) observer variation for LC delineation on each image modality. Results LCCT-LC10T1 provided the best conformal index (CI) and degree of inclusion (DI), increasing by 2.08% and 4.48% compared to LCCT-LCT2, 11.36% and 2.94% for LCCT-LC2T1, and 8.89% and 7.69% for LC5T1-LCCT, respectively. The center of mass (COM) of LCCT-LC10T1 decreased by 17.86%, 6.12% and 13.21% compared with that of LCCT-LCT2, LCCT-LC2T1 and LCCT-LC5T1, respectively. The agreement of LC delineation was strongest for 10th min DE-TIWI (coefficient of variation, COV = 2.30%, Inter-CIgen = 87.06%, Intra-CIgen = 92.64%). Conclusion For patients with a low SCS (SCS ≤ 2) after BCS, it is feasible to contour the LC based on prone DE-MR simulation images. Furthermore, the LC derived from prone DE-T1WI at 10 min was found to be most similar to that derived from prone CT simulation scans using titanium surgical clips regardless of the volume and location of the LC. Inter(intra)variability was minimal for the delineation of the LC based on 10th min DE-TIWI.

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Delayed Contrast Enhanced Magnetic Resonance Simulation Imaging in Prone Position for Radiotherapy After Breast Conserving Surgery: Assessing the Application in Lumpectomy Cavity Delineation Using Deformable Image Registration

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.792 ◽

2020 ◽

Vol 108 (3) ◽

pp. e331-e332

Author(s):

C. Zhao ◽

J. Li ◽

W. Wang

Keyword(s):

Magnetic Resonance ◽

Image Registration ◽

Prone Position ◽

Deformable Image Registration ◽

Breast Conserving Surgery ◽

Lumpectomy Cavity ◽

Contrast Enhanced

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Placement and Visualization of Surgical Clips in the Lumpectomy Cavity of Patients with Stage 0, I, and II Breast Cancer Treated with Breast Conserving Surgery and Radiation Therapy (BCS+RT)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2010.07.601 ◽

2010 ◽

Vol 78 (3) ◽

pp. S251-S252 ◽

Cited By ~ 1

Author(s):

U. Patel ◽

B.G. Haffty ◽

M. Azu ◽

T. Kearney ◽

N.J. Yue ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Breast Conserving Surgery ◽

Surgical Clips ◽

Lumpectomy Cavity

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MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

Radiology and Oncology ◽

10.1515/raon-2017-0014 ◽

2017 ◽

Vol 51 (2) ◽

pp. 160-168 ◽

Cited By ~ 4

Author(s):

Noora Al-Hammadi ◽

Palmira Caparrotti ◽

Saju Divakar ◽

Mohamed Riyas ◽

Suparna Halsnad Chandramouli ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Clinical Target Volume ◽

Breast Conserving Surgery ◽

Target Volume ◽

Observer Variation ◽

Breast Cancer Surgery ◽

Conformity Index ◽

Breast Cancer Patients ◽

Ct And Mri

Abstract Background Omitting the placement of clips inside tumour bed during breast cancer surgery poses a challenge for delineation of lumpectomy cavity clinical target volume (CTVLC). We aimed to quantify inter-observer variation and accuracy for CT- and MRI-based segmentation of CTVLC in patients without clips. Patients and methods CT- and MRI-simulator images of 12 breast cancer patients, treated by breast conserving surgery and radiotherapy, were included in this study. Five radiation oncologists recorded the cavity visualization score (CVS) and delineated CTVLC on both modalities. Expert-consensus (EC) contours were delineated by a senior radiation oncologist, respecting opinions of all observers. Inter-observer volumetric variation and generalized conformity index (CIgen) were calculated. Deviations from EC contour were quantified by the accuracy index (AI) and inter-delineation distances (IDD). Results Mean CVS was 3.88 +/− 0.99 and 3.05 +/− 1.07 for MRI and CT, respectively (p = 0.001). Mean volumes of CTVLC were similar: 154 +/− 26 cm3 on CT and 152 +/− 19 cm3 on MRI. Mean CIgen and AI were superior for MRI when compared with CT (CIgen: 0.74 +/− 0.07 vs. 0.67 +/− 0.12, p = 0.007; AI: 0.81 +/− 0.04 vs. 0.76 +/− 0.07; p = 0.004). CIgen and AI increased with increasing CVS. Mean IDD was 3 mm +/− 1.5 mm and 3.6 mm +/− 2.3 mm for MRI and CT, respectively (p = 0.017). Conclusions When compared with CT, MRI improved visualization of post-lumpectomy changes, reduced interobserver variation and improved the accuracy of CTVLC contouring in patients without clips in the tumour bed. Further studies with bigger sample sizes are needed to confirm our findings.

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The impact of different simulation modalities on target volume delineation in breast-conserving radiotherapy

10.21203/rs.3.rs-27116/v1 ◽

2020 ◽

Author(s):

Meng Jin ◽

Xia Liu ◽

Jiabin Ma ◽

Xiansong Sun ◽

Hongnan Zhen ◽

...

Keyword(s):

Ct Images ◽

Conformity Index ◽

Mr Images ◽

Mean Values ◽

Surgical Clips ◽

Tumor Bed ◽

Volume Delineation ◽

Ct Simulation ◽

The Mean ◽

The Impact

Abstract Background In the management of breast-conserving radiotherapy, computed tomography (CT) simulation is now commonly used to identify tumor bed while has difficult ies defining precisely. We aimed to evaluate the impact of magnetic resonance (MR) and CT simulation on defining the postoperative tumor bed for breast-conserving radiotherapy in patients without the aid of surgical clips. Methods From August 2018 to March 2019, twenty patients with T 1 - 2 N 0 M 0 breast cancer at our situation were enrolled. All the patients underwent breast-conserving surgery without implantation of surgical clips and were prepared to receive radiotherapy. CT and MR images were acquired on the same day for each patient. Three radiation oncologists independently assigned cavity visualization score (CVS) and delineated the tumor bed based on first the CT then the MR images with a 14-day interval for each patient. Interobserver variability was assessed by volumes, generalized conformity index (CI gen ) and the distance between the centers of mass (dCOM). Differences in mean values for parameters were tested by paired t -test or one-way analysis of variance, as appropriate. Results The median age of the enrolled patients was 48 years old. First, the mean volumes of tumor bed derived from MR were 22%, 27% and 21% smaller than those based on CT images for each observer. Second, the mean CI gen was significantly superior, and dCOM was smaller for MR than for CT images (CI gen : 0.59 vs 0.52, P = 0.008; dCOM: 1.30 cm vs 1.39 cm, P = 0.095). Third, the mean CVS was 3.23±1.34 and 2.43±0.92 for MR and CT images, respectively ( P = 0.035). In the subgroup with a CT-based CVS≥3, the mean dCOM obtained from CT was larger than that from the MR images (1.35 cm vs 1.19 cm, P = 0.048). Last, there was a positive association between the CVS and CI gen for both modalities (CT: r = 0.699, P = 0.001; MR: r = 0.895, P ＜ 0.001). Conclusion Compared to CT, MR can improve the visualization of changes in the postoperative tumor bed. In addition, MR can yield a more precise definition of the tumor bed and improve the consistency of tumor bed contouring in patients without surgical clips.

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Evaluation of the performance of deformable image registration between planning CT and CBCT images for the pelvic region: comparison between hybrid and intensity-based DIR

Journal of Radiation Research ◽

10.1093/jrr/rrw123 ◽

2017 ◽

Vol 58 (4) ◽

pp. 567-571 ◽

Cited By ~ 11

Author(s):

Yoshiki Takayama ◽

Noriyuki Kadoya ◽

Takaya Yamamoto ◽

Kengo Ito ◽

Mizuki Chiba ◽

...

Keyword(s):

Image Registration ◽

Center Of Mass ◽

Estimation Method ◽

Intensity Modulated Radiation Therapy ◽

Deformable Image Registration ◽

Seminal Vesicles ◽

Dice Similarity Coefficient ◽

Dose Estimation ◽

Anatomical Information ◽

Planning Ct

Abstract This study aimed to evaluate the performance of the hybrid deformable image registration (DIR) method in comparison with intensity-based DIR for pelvic cone-beam computed tomography (CBCT) images, using intensity and anatomical information. Ten prostate cancer patients treated with intensity-modulated radiation therapy (IMRT) were studied. Nine or ten CBCT scans were performed for each patient. First, rigid registration was performed between the planning CT and all CBCT images using gold fiducial markers, and then DIR was performed. The Dice similarity coefficient (DSC) and center of mass (COM) displacement were used to evaluate the quantitative DIR accuracy. The average DSCs for intensity-based DIR for the prostate, rectum, bladder, and seminal vesicles were 0.84 ± 0.05, 0.75 ± 0.05, 0.69 ± 0.07 and 0.65 ± 0.11, respectively, whereas those values for hybrid DIR were 0.98 ± 0.00, 0.97 ± 0.01, 0.98 ± 0.00 and 0.94 ± 0.03, respectively (P < 0.05). The average COM displacements for intensity-based DIR for the prostate, rectum, bladder, and seminal vesicles were 2.0 ± 1.5, 3.7 ± 1.4, 7.8 ± 2.2 and 3.6 ± 1.2 mm, whereas those values for hybrid DIR were 0.1 ± 0.0, 0.3 ± 0.2, 0.2 ± 0.1 and 0.6 ± 0.6 mm, respectively (P < 0.05). These results showed that the DSC for hybrid DIR had a higher DSC value and smaller COM displacement for all structures and all patients, compared with intensity-based DIR. Thus, the accumulative dose based on hybrid DIR might be trusted as a high-precision dose estimation method that takes into account organ movement during treatment radiotherapy.

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Displacement of the lumpectomy cavity defined by surgical clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast-conserving surgery: a comparative study

British Journal of Radiology ◽

10.1259/bjr.20130416 ◽

2013 ◽

Vol 86 (1030) ◽

pp. 20130416 ◽

Cited By ~ 9

Author(s):

Y Ding ◽

J Li ◽

W Wang ◽

S Wang ◽

T Fan ◽

...

Keyword(s):

Comparative Study ◽

Ct Scan ◽

Breast Conserving Surgery ◽

Partial Breast Irradiation ◽

External Beam ◽

Breast Irradiation ◽

4D Ct ◽

Surgical Clips ◽

Lumpectomy Cavity

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Surgical Clips in Breast-conserving Surgery: Do they Represent the Tumour Bed Accurately?

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666180821121254 ◽

2019 ◽

Vol 15 (6) ◽

pp. 573-577

Author(s):

Ozlem Demircioglu ◽

Erkin Aribal ◽

Meral Uluer ◽

Zerrin Ozgen ◽

Fatih Demircioglu

Keyword(s):

Breast Cancer ◽

Standard Treatment ◽

Breast Conserving Surgery ◽

Radiotherapy Planning ◽

Surgical Scar ◽

Surgical Clips ◽

End Of Treatment

Introduction: Radiotherapy after Breast-Conserving Surgery (BCS) is a standard treatment for breast cancer. Currently, surgical clips are used to determine the tumour bed before radiotherapy planning. This study aimed to evaluate the migration of these clips on mammograms. Methods: The study was conducted on 121 females who were treated with radiotherapy after BCS at their first radiologic control examination 6 months after the end of treatment. MLO and CC views of all cases were evaluated regarding the clips. The distance between the surgical scar centre and the centre of the area covered by the clips was measured on both MLO and CC projections and recorded separately. This distance was determined as the clip displacement. A displacement ≤10 mm was recorded as no displacement. Results: The clips were out of the images and were not evaluated in 45 cases (37.2%) on CC and in 9 cases (7.4%) on MLO projections. There were no clip displacements in 37 (30.6%) cases on CC and in 43 (35.5%) cases on MLO views. The amount of displacement ranged from 11 to 56 mm with a mean of 24.38 mm on CC views, while on MLO projections, displacement ranged from 11 to 66 mm with a mean of 24.42 mm. Conclusion: A clip displacement of greater than 10 mm was found in 64.5% of cases on MLO views. Therefore, we believe that the reliability of these clips for accurate delineation of the tumour bed in radiotherapy planning is controversial and other methods must be added.

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